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General NPI Number Information
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NPI Number | 1386069565
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Entity Type | Individual
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Provider Name | JEFF PETERSON L.P.C., L.C.P.C.
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Gender | Male
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Dates
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Enumeration Date | 02/25/2014
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 211 SIOUX POINT RD STE 300
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5492
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Country | US
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Telephone | 605-215-6695
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SIOUX POINT RD STE 300
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5492
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Country | US
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Telephone | 605-215-6695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 101101
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2448
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 30907
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License Number State | SD
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